ABSTRACT
Transcatheter aortic valve implantation is one of the most significant technological advances in cardiovascular medicine. It offers a safe alternative in high risk cardiac patients with proven durability, economical viability and survival advantage. Current trials may expand its application in intermediate or low risk groups.
Subject(s)
Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement/methods , Acute Kidney Injury/epidemiology , Balloon Valvuloplasty/methods , Heart Valve Prosthesis , Humans , Length of Stay , Minimally Invasive Surgical Procedures , Multimodal Imaging , Pacemaker, Artificial , Patient Care Team , Stroke/epidemiology , Tomography, X-Ray Computed , Transcatheter Aortic Valve Replacement/adverse effects , Vascular System Injuries/epidemiologyABSTRACT
BACKGROUND: The use of transcatheter mitral valve repair (TMVR) has gained widespread acceptance in Europe, but data on immediate success, safety, and long-term echocardiographic follow-up in real-world patients are still limited. OBJECTIVES: The aim of this multinational registry is to present a real-world overview of TMVR use in Europe. METHODS: The Transcatheter Valve Treatment Sentinel Pilot Registry is a prospective, independent, consecutive collection of individual patient data. RESULTS: A total of 628 patients (mean age 74.2 ± 9.7 years, 63.1% men) underwent TMVR between January 2011 and December 2012 in 25 centers in 8 European countries. The prevalent pathogenesis was functional mitral regurgitation (FMR) (n = 452 [72.0%]). The majority of patients (85.5%) were highly symptomatic (New York Heart Association functional class III or higher), with a high logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) (20.4 ± 16.7%). Acute procedural success was high (95.4%) and similar in FMR and degenerative mitral regurgitation (p = 0.662). One clip was implanted in 61.4% of patients. In-hospital mortality was low (2.9%), without significant differences between groups. The estimated 1-year mortality was 15.3%, which was similar for FMR and degenerative mitral regurgitation. The estimated 1-year rate of rehospitalization because of heart failure was 22.8%, significantly higher in the FMR group (25.8% vs. 12.0%, p[log-rank] = 0.009). Paired echocardiographic data from the 1-year follow-up, available for 368 consecutive patients in 15 centers, showed a persistent reduction in the degree of mitral regurgitation at 1 year (6.0% of patients with severe mitral regurgitation). CONCLUSIONS: This independent, contemporary registry shows that TMVR is associated with high immediate success, low complication rates, and sustained 1-year reduction of the severity of mitral regurgitation and improvement of clinical symptoms.
Subject(s)
Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Aged , Catheterization , Echocardiography , Europe , Female , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/methods , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Registries , Time Factors , Treatment OutcomeABSTRACT
Remarkably little evidence exists that cardiac resynchronization therapy (CRT) is effective in patients who have atrial fibrillation (AF) but who otherwise seem suitable for this treatment. The landmark trials of CRT generally excluded patients with AF because atrioventricular (AV) resynchronization was considered a possibly important mechanism by which CRT might deliver its benefits. The only landmark trial that included many patients with AF confirmed marked benefit among patients in sinus rhythm but no benefit among those with AF. Evidence is lacking that biventricular rather than AV resynchronization is an important mechanism for delivering the benefits of CRT.
